/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/obstetrics/,

/clinical/cckm-tools/content/order-sets/inpatient/obstetrics/name-109733-en.cckm

201612347

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Obstetrics

IP - Cesarean Delivery - PostProcedure [6265]

IP - Cesarean Delivery - PostProcedure [6265] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Obstetrics


SmartSet: IP - CESAREAN DELIVERY - POSTPROCEDURE (ID:6265)
General Information
Display name: IP - Cesarean Delivery - PostProcedure
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. Cesarean
2. Delivery
3. Birth
4. C Section
5. C-Section
SmartSet notes:
Description:
Web information: Title URL
1.
Questionnaire:
Configuration
Patient Care Orders
Vital Signs
Vital Signs EVERY 4 HOURS, Starting S, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Activity
Page 1 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Ambulate Ad Lib CONTINUOUS, Routine
AD LIB:
AMBULATE: ad lib
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Ambulate with assistance until patient is able to
ambulate independently., Post-Op/Phase II
Activity Ambulate with Assistance CONTINUOUS, Routine
AD LIB:
AMBULATE: with assistance,4x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Activity Chair Ad Lib CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR: ad lib
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Activity Bedrest with Bathroom Privileges CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: with bathroom privileges
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Patient May Shower CONTINUOUS, Post-Op/Phase II
Nutrition
Diet - Diabetic EFFECTIVE NOW, Starting S, Routine
Patient Type: Adult
Room Service Class:
Diet Type: Diet Modifications
Diet Modifications: Diabetes
Bedside Meal Instructions:
Post-Op/Phase II
Page 2 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

General Diet EFFECTIVE NOW, Starting S, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Respiratory
Oxygen Therapy CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device:
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Respiratory Therapy per Protocol CONTINUOUS, Routine
Protocol Type:
Post-Op/Phase II
Aspiration Precautions CONTINUOUS, Routine
Solid Consistency:
Liquid Consistency:
Medication Administration:
Supervision:
Positioning Strategies:
Feeding Strategies:
Post-Op/Phase II
Incentive Spirometry EVERY 2 HOURS, Routine, While awake., Post-
Op/Phase II
Cough And Deep Breathe EVERY 2 HOURS, Routine, While awake., Post-
Op/Phase II
Intake and Output
Measure Intake And Output EVERY 8 HOURS For 24 Hours, Routine, Post-
Op/Phase II
Measure Intake And Output EVERY 4 HOURS For 24 Hours, Routine, Post-
Op/Phase II
Bladder Management
Maintain Urinary Catheter CONTINUOUS, Routine, To discontinue this order,
enter a new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Discontinue when patient ambulatory without
syncope and output is greater than 30 mL/hour.,
Post-Op/Phase II
Patient Monitoring
Measure Weight 1X DAILY, Routine
Weigh With? Portable Scale
Weigh when?
Standing preferred, Post-Op/Phase II
Pulse Oximetry ONCE For 1 Occurrences, Routine, Post-Op/Phase II
Pulse Oximetry CONTINUOUS, Routine, Post-Op/Phase II
Page 3 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Cardiac Rhythm Monitoring - Adult CONTINUOUS, Routine
Indication:
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Post-Op/Phase II
Wound Care
Wound Care CONTINUOUS, Routine
Wound Type: Closed - Incision
Wound Site: Abdomen
Wound Location: Anterior
Assess Frequency: EVERY 8 HOURS
Care Frequency: EVERY 8 HOURS
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing:
Secondary Dressing:
Post-Op/Phase II
Non-Categorized Patient Care Orders
Breast Feeding Mom
Breast Feeding Mom Tray Please Provide Tray for Breast Feeding Mom: Yes
Routine, CONTINUOUS, Post-Op/Phase II
Consult Lactation Consultant ONCE For 1 Occurrences, Routine, Patient's
assigned RN is to arrange for the Lactation
Consultant or designee to complete the consult.
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Breast Pump CONTINUOUS, Routine
Send Request to CS? Yes
Deliver Equipment To: Nurses Station
Post-Op/Phase II
Bottle Breast Milk Collection ONCE For 1 Occurrences, Routine
Volume: 80 mL
Quantity: 10
Post-Op/Phase II
Contingency Parameters
Page 4 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Notify Provider Provider to Notify: Provider
Notify based on: Blood Pressure,Temperature,Heart
Rate,Blood Glucose,Pulse Oximetry,Urine
Output,Other
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 105
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm): 110
If heart rate < (bpm): 60
If blood glucose > (mg/dL): 120
If blood glucose < (mg/dL):
Pulse Oximetry < (%): 90
If urine output < (mL): 30 for 4 hours
Other: If central venous pressure less than 3 or
greater than 15 mmHg.,If patient on heparin and
platelets decrease by half from baseline or are below
normal range.,If persistent back pain, lower extremity
numbness or weakness and on heparin and
epidural.,If saturating one pad every hour.
Post-Op/Phase II
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis
Low VTE Risk
VTE Prophylaxis - Reason Not Ordered ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response)
enoxaparin (LOVENOX) subcutaneous injection 40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk
enoxaparin (LOVENOX) subcutaneous injection 40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection 5,000 units, Subcutaneous, EVERY 8 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT)
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY)
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk
Sequential Compression Device (SCD)
(TREATMENT)
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY)
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Page 5 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Apply and Maintain Anti-Embolism Stocking CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis
VTE Prophylaxis - Reason Not Ordered ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion
lidocaine (LMX) 4% topical dressing kit Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
Post-Op/Phase II
lidocaine (XYLOCAINE) 1% injection 0.1-0.4 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into
center of wheal. Use if IV is needed within 30
minutes. Choice of medication should be based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Post-Op/Phase II
sodium chloride (bacteriostatic) 0.9 % injection 0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into
center of wheal. Use if IV is needed within 30
minutes. Choice of medication should be based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Post-Op/Phase II
IV Fluids
Insert and Maintain Peripheral IV CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
sodium chloride 0.9 % infusion at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
lactated ringers infusion at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
Medications - General
Page 6 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Analgesics - ketOROLAC followed by oral ibuprofen
ketOROLAC followed by oral ibuporfen "Followed by" Linked Panel
ketOROLAC (TORADOL) injection 30 mg, Intravenous, EVERY 6 HOURS For 5
Doses
Mild to moderate pain
ibuprofen (MOTRIN) tab 600 mg, Oral, EVERY 6 HOURS PRN, pain
Mild to moderate pain
Analgesics - Oral Opioids
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
Severe pain
Post-Op/Phase II
oxycodone tab 5-15 mg, Oral, EVERY 3 HOURS PRN, pain
Severe pain
Post-Op/Phase II
Analgesics - Intravenous HYDROmorphone for 24 hours
Analgesics - Intravenous HYDROmorphone for
24 hours
"Followed by" Linked Panel
HYDROmorphone PF (DILAUDID) injection 0.5 mg, Intravenous, EVERY 1 HOUR PRN For 4
Hours, pain
May use for breakthrough pain or if patient cannot
tolerate oral oxycodone/acetaminophen
Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection 0.5 mg, Intravenous, EVERY 2 HOURS PRN For
20 Hours, pain
May use for breakthrough pain or if patient cannot
tolerate oral oxycodone/acetaminophen
Post-Op/Phase II
Anti-emetics
ondansetron (ZOFRAN ODT) disintegrating tab 4 mg, Oral, EVERY 8 HOURS PRN,
nausea/vomiting, First Line
Place on tongue and allow to dissolve.
Post-Op/Phase II
ondansetron (ZOFRAN) injection 4 mg, Intravenous, EVERY 8 HOURS PRN,
nausea/vomiting, First Line when unable to take
orally, Post-Op/Phase II
prochlorperazine (COMPAZINE) injection 10 mg, Intravenous, EVERY 8 HOURS PRN,
nausea/vomiting, Second Line when unable to take
orally
If unable to tolerate oral medication
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab 10 mg, Oral, EVERY 8 HOURS PRN, nausea,
Second Line, Post-Op/Phase II
prochlorperazine (COMPAZINE) rectal
suppository
25 mg, Rectal, EVERY 12 HOURS PRN,
nausea/vomiting, Second Line, Post-Op/Phase II
Bowel Management - Scheduled
docusate sodium (COLACE) cap 100 mg, Oral, 2 X DAILY
Hold for loose stools
Post-Op/Phase II
Bowel Management - PRN
Page 7 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

polyethylene glycol (MIRALAX) oral powder 17 g, Oral, 1 X DAILY PRN, constipation, First line
therapy for constipation despite scheduled stool
softener., Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp
30 mL, Oral, 1 X DAILY PRN, constipation, Second
line therapy when there is no response to first line
therapy., Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository 10 mg, Rectal, 1 X DAILY PRN, constipation, Post-
Op/Phase II
Antacids
calcium carbonate (TUMS) chew tab 500 mg, Oral, 3 X DAILY PRN, heartburn, Post-
Op/Phase II
alum-mag-simeth (MYLANTA ES) 400-400-40
MG/5ML susp
30 mL, Oral, 3 X DAILY PRN, dyspepsia, heartburn,
Post-Op/Phase II
Hemorrhoids
dibucaine (NUPERCAINAL) 1 % ointment Topical, 4 X DAILY PRN, itching
For rectal discomfort
Post-Op/Phase II
Vaccinations
measles, mumps and rubella vaccine (MMR II)
vial
0.5 mL, Subcutaneous, PRIOR TO DISCHARGE For
1 Doses
If titer indicates non-immune or equivocal, administer
on day of discharge. Rubella status is ***.
Post-Op/Phase II
tetanus-diphtheria-pertussis vaccine 5-2.5-18.5
LF-MCG/0.5 (Tdap-BOOSTRIX) injection susp
0.5 mL, Intramuscular, PRIOR TO DISCHARGE For
1 Doses
If patient has never received as an adult OR unknown
AND patient is not allergic
Post-Op/Phase II
Non-Categorized General Medications
multivitamin prenatal tab 1 tab, Oral, 1 X DAILY, Post-Op/Phase II
ferrous sulfate tab 325 mg, Oral, 1 X DAILY
Administer with breakfast
Post-Op/Phase II
rho(D) immune globulin (RHOPHYLAC) injection 300 mcg, Intramuscular, ONCE PRN For 1 Doses, If
Rh negative, dose based on study results from blood
bank., for 5 Minutes, Post-Op/Phase II
simethicone (MYLICON) susp MULTIDOSE 80 mg, Oral, EVERY 4 HOURS PRN, gas, gastric
distension, Post-Op/Phase II
NOTE: NO anticoagulants unless approved by
Anesthesiology Acute Pain Service
4 X DAILY (NOTE ACKNOWLEDGE), Post-
Op/Phase II
Laboratory
Hematology
CBC WITHOUT DIFFERENTIAL NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Page 8 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

CBC WITH DIFFERENTIAL NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
HEMOGLOBIN NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
HEMOGLOBIN, WHOLE BLOOD NEXT AM For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
HEMATOCRIT NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Glucose, POC ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Post-Op/Phase II
Criteria
Suggestions:
Filter: UWIP ORDER SET RESTRICTION - HOSPITAL ENCOUNTERS EXCEPT ED -
NOT IP DC[3000400]
Restrict SmartSet:
Settings
Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Disallow user override:
Page 9 of 9
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:04:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org